Provider Demographics
NPI:1184650467
Name:OSTER, RANDAL ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:ALLEN
Last Name:OSTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 MURRAY HOLLADAY RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5185
Mailing Address - Country:US
Mailing Address - Phone:801-272-5083
Mailing Address - Fax:801-272-5094
Practice Address - Street 1:2040 MURRAY HOLLADAY RD
Practice Address - Street 2:SUITE 211
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5185
Practice Address - Country:US
Practice Address - Phone:801-272-5083
Practice Address - Fax:801-272-5094
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109512-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist